Provider Demographics
NPI:1134174709
Name:ROSENBLOOM, ISABEL LEVINE (MD)
Entity type:Individual
Prefix:MRS
First Name:ISABEL
Middle Name:LEVINE
Last Name:ROSENBLOOM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12255 DE PAUL DR
Mailing Address - Street 2:SUITE 490
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044-2510
Mailing Address - Country:US
Mailing Address - Phone:314-291-7766
Mailing Address - Fax:314-291-7767
Practice Address - Street 1:12255 DE PAUL DR
Practice Address - Street 2:SUITE 490
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2510
Practice Address - Country:US
Practice Address - Phone:314-291-7766
Practice Address - Fax:314-291-7767
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR6G08208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics